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*Ultrasound* > GB Abnormal > Flashcards

GB Abnormal Flashcards

1
Q

What is the term for calcification of the GB wall?

A

porcelain GB

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2
Q

What is the cause of porcelain GB?

A

it is unknown

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3
Q

Porcelain GB occurs in association with _____ and may represent some form of _____.

A

gallstone disease

chronic cholecystitis

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4
Q

What determines the sonographic appearance of porcelain GB?

A

the degree and pattern of calcification

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5
Q

When the entire GB wall is thickly calcified, a _____ _____ line with dense posterior _____ _____ is noted.

A

hyperechoic semilunar

acoustic shadowing

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6
Q

Mild calcification of the GB wall appears as a(n) _____ line with variable degrees of _____.

A

echogenic

posterior acoustic shadowing

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7
Q

With calcification of the GB wall, the luminal contents may be _____ (visible/not visible), interrupted clumps of _____ appear as _____ foci with posterior shadowing.

A

visible
calcium
echogenic

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8
Q

Why is the WES sign absent with a porcelain GB?

A

Because the GB wall is calcified

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9
Q

What is another term for adenomyomatosis?

A

Rokitansky-Aschoff Sinuses

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10
Q

Adenomyomatosis can be either focal or _____. Is it benign or malignant?

A

diffuse

benign

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11
Q

What happens to the GB physiologically to cause adenomyomatosis?

A

The diverticula in the GB wall become clogged with stones or sludge

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12
Q

What is the most common U/S appearance of adenomyomatosis?

A

tiny echogenic foci in the GB wall that create comet-tail artifacts

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13
Q

What is the most common appearance of adenomymatosis with doppler U/S?

A

echogenic foci with ringdown or twinkling artifact

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14
Q

What is another term for ringdown artifact?

A

twinkling artifact

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15
Q

The comet-tail artifact with ringdown or twinkling from adenomyomatosis is located where in the GB?

A

in the Rokitansky-Aschoff sinuses

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16
Q

If you don’t see twinkling artifact within the comet-tail artifact in the GB, what should be done?

A

Further study to rule out neoplasm.

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17
Q

Does not move, does not shadow =

A

polyps

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18
Q

Why is it important to distinguish between benign and malignant polyps?

A

Because benign are very common and malignant require early intervention to improve outcome.

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19
Q

What are the two most frequently used criteria to identify a polyp as benign?

A

multiplicity

size below 10mm

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20
Q

Malignancy of polyps has been documented in 37-88% of resected polyps that were

A

larger than 10mm

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21
Q

Other malignancy risk factors for a person with polyps are (6)

A

1) older than 60
2) single lesion
3) gallstone disease
4) rapid change in size
5) sessile morphology
6) doppler velocity of more than 20cm/sec and resistive index of less than 0.65

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22
Q

Approximately half of all polyps are _____ polyps.

A

cholesterol

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23
Q

This kind of polyp represents the focal form of GB cholesterolosis.

A

cholesterol polyp

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24
Q

Cholesterolosis results in the accumulation of _____ (such as _____ and _____) in the GB wall. It is a common _____ condition of the GB.

A

lipids
triglycerides
cholesterol
non-neoplastic

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25
Q

T or F? Polyps DO NOT roll and DO NOT produce posterior shadowing.

A

True

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26
Q

The diffuse form of cholesterolosis is called

A

strawberry GB

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27
Q

Where does strawberry GB get its name?

A

golden yellow lipid deposits agains the red GB mucosa

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28
Q

Cholesterolosis is usually asymptomatic but if there are symptoms, it is usually in the form of

A

colicky abdominal pain

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29
Q

Although cholesterolosis and adenomyomatosis appear similar, the main difference is that cholesterolosis doesn’t have

A

comet tail reverberation artifact (ring down or twinkling)

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30
Q

The 2 most common lesions that cause biliary obstruction are

A

gallstones

carcinoma of the pancreas head

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31
Q

The increase of what 2 hormones is usually associated with biliary obstruction?

A

serum alkaline phosphatase

bilirubin

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32
Q

The condition of irregular, tortuous, enlarged bile ducts is called

A

dilated intrahepatic ducts

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33
Q

Two other terms for dilated intrahepatic ducts are

A

parallel channel sign

shotgun sign

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34
Q

When bile ducts branch into star-shaped configurations, this is called

A

stellate confluence

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35
Q

Bile structues attenuate sound much _____ (more/less) than blood, which creates posterior acoustic enhancement.

A

less

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36
Q

Lots of posterior enhancement with bile structures =

A

dilated intrahepatic ducts (aka parallel channel sign or shotgun sign)

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37
Q

With the shotgun sign, these vessels are dilated, with the _____ being anterior to the _____.

A

CBD

MPV

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38
Q

The part of the biliary tree that dilates as a result of obstruction depends on the

A

level of obstruction

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39
Q

With this kind of obstruction, the entire system distends, including the GB.

A

distal CBD obstruction

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40
Q

With this kind of obstruction, the proximal ducts will distend and the GB will be contracted.

A

CHD obstruction

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41
Q

With Rt and LT hepatic duct obstruction, these ducts dilate

A

intrahepatic ducts

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42
Q

Congenital bile duct anomalies that consist of cystic dilation of the INTRA or EXTRA hepatic bile ducts are

A

choledochal cysts

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43
Q

The most widely used classification system for choledochal cysts divides them into _____ groups.

A

5

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44
Q

The most common type of cystic dilation with choledochal cysts is

A

Type 1 - dilation of the CBD

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45
Q

With Type 1 choledochal cyst classification, fusiform dilation occurs between the distal _____ and MPV.

A

CBD

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46
Q

This type of choledochal cyst classification is very rare and occurs with true diverticuli of the bile ducts.

A

Type 2

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47
Q

This choledochal cyst classification is confined to the intraduodenal portion of the CBD.

A

Type 3

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48
Q

Type 3 of choledochal cyst classification is also referred to as

A

choledochoceles

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49
Q

This type of choledochal cyst classification occurs with multiple intra and extra hepatic biliary dilations.

A

Type 4a

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50
Q

This type of choledochal cyst classification occurs with only extrahepatic biliary dilations.

A

Type 4b

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51
Q

Type 5 of the choledochal cyst classification system is also called

A

Caroli’s Disease

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52
Q

Which types of the choledochal cyst classification system are intrahepatic and which are extrahepatic?

A

INTRA
Type 4a and 5

EXTRA
Type 1, 2, 3, 4a, 4b

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53
Q

Sonographically, choledochal cysts appear as a

A

cystic structure with may contain internal sludge, stones, or solid neoplasm

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54
Q

Surgical resection is advocated for choledochal cysts because

A

a proven risk of cholangiocarcinoma with all choledochal cysts

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55
Q

_____ is necessary to ensure that the dilation is not a result of distal neoplasm, especially in the case of Type _____ choledochal cysts.

A

ERCP

1

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56
Q

Caroli’s disease =

A

intrahepatic

57
Q

Multiple cyst structures that converge toward the porta hepatis, and communicating with the bile ducts, are the sonographic findings of what condition?

A

Caroli’s Disease

58
Q

With Caroli’s Disease, _____ and _____ may accumulate in the ectatic ducts that will result in posterior acoustic shadowing.

A

sludge

calculi

59
Q

This syndrome is caused by a stone in the cystic duct, which causes compression of the CHD. Clinical symptoms are jaundice, pain, and fever.

A

Mirizzi Syndrome

60
Q

With Mirizzi Syndrome, the stone is often impacted in the _____ cystic duct and the accompanying inflammation and edema result in the obstruction of the adjacent _____.

A

distal

CHD

61
Q

You should consider this condition when biliary obstruction, with dilation of the biliary ducts, is seen at the level of the CHD; in conjunction with a picture of acute or chronic cholecystitis.

A

Mirizzi Syndrome

62
Q

Blood clot in the biliary tree =

A

Hemobilia

63
Q

Air within the biliary tree =

A

Pneumobilia

64
Q

This results from previous biliary intervention, like biliary-enteric anastomoses or CBD stents.

A

pneumobilia

65
Q

What is the sonographic appearance of pneumobilia?

A

Intrahepatic linear echogenic regions that often produce distal acoustic shadowing.

66
Q

Posterior dirty shadowing and reverberation artifacts are seen, with movement of the air bubbles, best seen after changing the patient’s position, is diagnostic of this

A

pneumobilia

67
Q

Inflammation of the ducts. Antecedent biliary obstruction is an essential component of this associated in 85% of cases with CBD stones.

A

acute (bacterial) cholangitis

68
Q

These are clinical presentations of _____:

Leukocytosis
Elevated alkaline phosphatase and bilirubin
Charcot’s triad (fever, RUQ pain, jaundice)

A

acute (bacterial) cholangitis

69
Q

What makes up Charcot’s triad?

A

fever
RUQ pain
jaundice

70
Q

T or F? Acute cholangitis is a medical emergency.

A

True

71
Q

With colangitis, the bile is most commonly infected by _____ _____ _____, which are often retrieved in blood cultures.

A

gram-negative enteric bacteria

72
Q

An inflammatory process affecting the biliary tree in the advanced stages of HIV infection.

A

HIV Cholangiopathy

73
Q

Patients present with severe RUQ or epigastric pain, markedly elevated alkaline phosphatase BUT normal bilirubin levels.

A

HIV cholangiopathy

74
Q

Elevated alkaline phosphatase and bilirubin =

Elevated alkaline phosphatase but not bilirubin =

A

cholangitis

HIV cholangiopathy

75
Q

Bile duct wall thickening, intra and extra hepatic
Focal structures and dilations
CBD dilation
Diffuse GB wall thickening

A

HIV cholangiopathy

76
Q

A chronic disease process that affects the ENTIRE biliary tree. More frequently affects men with a median age of 39 years.

A

Primary Sclerosing Cholangitis

77
Q

With primary sclerosing cholangitis, about 80% of people also have _____, usually _____.

A

concomitant inflammatory bowel disease

ulcerative colitis

78
Q

T or F? With primary sclerosing cholangitis most patients are asymptomatic.

A

True

79
Q

Cholangiocarcinoma develosp in 7-30% of people with _____.

A

primary sclerosing cholangitis

80
Q

Irregular, circumferential bile duct wall thickening of varying degrees, encroaching on and narrowing the lumen. Focal strictures and dilations of the bile ducts ensue.

A

primary sclerosing cholangitis

81
Q

Is liver disease required in the latter stages of primary sclerosing cholangitis?

A

Yes

82
Q

Can primary sclerosing cholangitis recur after a liver transplant?

A

Yes

83
Q

This is a parasitic roundworm which as been estimated to infect up to 25% of the world’s population.

A

Ascariasis

84
Q

Ascariasis is transferred by _____ route and is most common in _____.

A

fecal-oral route

children

85
Q

An ascariasis worm is generally _____ long and up to _____ in diameter.

A

20-30cm

6mm

86
Q

An ascariasis worm is active within the _____ and may enter the biliary tree retrogradely through the _____, causing biliary obstruction.

A

small bowel

Ampulla of Vater

87
Q

The appearance of ascariasis depends on

A

the number of worms within the bile ducts

88
Q

With ascariasis a single worm appears as a tube or as a parallel _____ _____ within the bile ducts and can be similar in appearance of a biliary _____ (so it is important to know patient history).

A

echogenic line

stent

89
Q

Transversely, an ascariasis worm has a target appearance because

A

the rounded worm surrounded by the bile duct

90
Q

When ascariasis infestation is heavy, multiple worms may lie adjacent to each other within a distended _____ give a _____-like appearance.

A

duct

spaghetti

91
Q

This is an uncommon condition of the GB. It is most common in the elderly. It has a 3:1 female to male predominance. It is associated with gallstones, chronic gallstones disease, and resultant dysplasia.

A

GB carcinoma

92
Q

About 98% of GB carcinomas are _____, with squamous cell carcinoma and _____ accounting for the rest.

A

adenocarcinomas

metastases

93
Q

The patterns of this condition are:

1) Mass arising in the GB fossa, obliterating the GB and invading the adjacent liver (most common)
2) Focal or diffuse, markedly abnormal and irregular wall thickening
3) Intraluminal polypoid mass

A

GB carcinoma

94
Q

What are the 2 patterns of GB Carcinoma tumor spread?

A

1) contiguous hepatic spread (most common)

2) lymphatic spread

95
Q

Why is contiguous hepatic invasion the most common?

A

Because the GB wall is thin and little connective tissue separates it from the liver parenchyma.

96
Q

With contiguous hepatic invasion, GB tumors also extend along the _____ (vessel) into the porta hepatic, where they mimic _____ _____.

A

cystic duct

hilar cholangiocarcinomas

97
Q

With contiguous hepatic invasion, tumor extension into the _____ (vessels) or encasement of the PV or _____ (vessel) may ensue.

A

bile ducts

hepatic artery

98
Q

With contiguous hepatic invasion, direct invasion into adjacent loops of _____, especially the _____ or _____, is not unusual. As well as _____ to the peritoneum.

A

bowel
duodenum
colon
metastases

99
Q

This type of spread may occur in the absence of invasion of the adjacent organs.

A

lymphatic spread

100
Q

The first nodes affected with lymphatic spread are in the

A

hilar region

101
Q

What is the only chance of cure with lymphatic spread?

A

surgical resection

102
Q

With lymphatic spread, if the tumor is not confined to the mucosa, an extended _____ involving resection of 3-5mm rim of adjacent liver tissue is removed and dissection is required of the bile and cystic ducts and regional _____ _____.

A

cholecystectomy

lymph nodes

103
Q

T or F? The sonographic appearance of lymphatic spread varies.

A

True

104
Q

Why is it hard to see the masses that replace the GB fossa sometimes with lymphatic spread?

A

Because they are small and blend into the liver

105
Q

The absence of a normal GB with no history of cholecystectomy (removal) should raise suspicion with

A

lymphatic spread

106
Q

This kind of GB malignancy may appear as a polypoid mass.

A

GB adenocarcinomas

107
Q

Which malignancy is the cause of more than half of metastases to the GB?

A

melanoma

108
Q

This is an uncommon neoplasm that may arise from any portion of the biliary tree. The highest incidence is in northeast Thailand.

A

cholangiocarcinoma

109
Q

Another term for cholangiocarcinoma is

A

bile duct carcinoma

110
Q

Cholangiocarcinoma has 2 types which are

A

intrahepatic

extrahepatic

111
Q

This is the least common bile duct carcinoma, but represents the 2nd most common primary malignancy in the liver.

A

intrahepatic cholangiocarcinoma

112
Q

Incidence of intrahepatic cholangiocarcinoma has increased dramatically due to people with _____ and long-term _____.

A

cirrhosis

hepatitis

113
Q

The most common findings with intrahepatic cholangiocarcinoma are a large hepatic mass with (3)

A

hypervascularity
solid
hetergeneous echotexture

114
Q

A clue to differentiate intrahepatic cholagniocarcinoma from hepatocellular carcinoma is there is a much higher incidence of _____ with intrahepatic cholangiocarcinoma.

A

ductual obstruction

115
Q

The most common appearance of intrahepatic cholangiocarcinoma is

A

1 or more polypoid masses confined to the bile ducts

116
Q

The risk factors for cholangiocarcinoma are (2)

A

1) primary sclerosing cholangitis (most common)

2) chronic biliary stasis and inflammation

117
Q

Cholangiocarcinoma is classified by anatomic location, such as (3)

A

1) intrahepatic (aka peripheral)
2) hilar (aka Klatskins)
3) distal

118
Q

Another term for intrahepatic is

A

peripheral

119
Q

Hilar cholangiocarcinoma =

A

Klatskins tumor

120
Q

The overall prognosis for cholangiocarcinoma is

A

dismal

121
Q

Why does U/S play an important role in both detection and staging of Klatskins?

A

because it is often the first modality used in assessment of these tumors and is performed prior to any biliary manipulation or stent placement.

122
Q

This a cholangiocarcinoma located at the hepatic hilum (junction of the rt and lt hepatic duct)

A

Klatskin tumor

123
Q

The results of a cholangiocarcinoma located at the hepatic hilum (Klatskin tumor) is

A

intrahepatic dilation ONLY

124
Q

The junction of the rt and lt hepatic duct is called

A

hepatic hilum

125
Q

Curative treatment for hilar cholangiocarcinoma is

A

surgical resection

126
Q

Patients with an unresectable hilar cholangiocarcinoma tumor

A

die within 12 months

127
Q

This kind of cholangiocarcinoma is clicinally indistinguishable from the hilar forms with progressive jaundice seen in 75-90% of patients.

A

distal cholangiocarcinoma

128
Q

Metastases of the GB mimic different appearances of _____ and affects both _____ and _____ hepatic ducts.

A

cholangiocarcinoma
intra
extra

129
Q

The primary sites of malignancy for metastases of the GB are (3)

A

breast
colon
melanoma

130
Q

This is the most common malignant neoplasm that obstructs the biliary tree.

A

pancreatic adenocarcinoma

131
Q

Pancreatic adenocarcinoma at the head of the pancreas typically causes this GB condition

A

Courvoisier GB

132
Q

This is an enlarged, often palpable GB in a patient with carcinoma of the pancreas head. It is associated with jaundice due to obstruction of the CBDs.

A

Courvoisier GB

133
Q

The diagnosis of a hydropic GB is solely made on the _____ of the GB. Do not rely on measurements. Some GB happen to be small and others large.

A

non-compressibility

134
Q

Ascariasis =

A

Round worms

135
Q

Tumor invasion of bile ducts, encasement of the PV, or hepatic artery occurs with this GB carcinoma

A

Klatskin tumor

136
Q

With Klatskin Tumor, what state would the GB be in and why?

A

Contracted
Because with Klatskin tumor (a cholangiocarcinoma) the hepatic hilum is clogged by mass so bile can’t get out of liver and into GB or CBD.

137
Q

Air in bile ducts =

A

Pneumobilia

138
Q

A mass that is hypervascular, irregular, with multiple stones in the GB is most likely

A

GB cancer

*Ultrasound* (14 decks)

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